Abstract: Objective: To observe the application effects of ultrasound-guided transversus abdominis plane block (TAPB) combined rectus sheath block (RSB) on overweight surgical patients in Gynaecology. Methods: 60 overweight patients underwent selective total open hysterectomy were randomly divided into general anesthesia group (group G) and TAPB combined RSB group (group TR) with 30 patients in each group. General anesthesia was performed routinely in both groups, then no more operations were performed in group G; ultrasound-guided biliteral TAPB combined RSB were performed in group TR. The patients in both groups used patient-controlled intravenous analgesia (PCIA) after operation, which prepared according to standard weight. The intraoperative remifentanil dosage, anaesthesia anabiosis time, the number of PCIA pressing in 24h after operation, early out-of-bed activity time after operation, incidence rate of postoperative nausea and vomiting (PONV) of patients in both groups were recorded. The VAS score during rest and exercise immediately after leaving postanesthesia care unit (PACU), as well as 2h, 4h, 8h, 12h, 24h after operation of patients in 2 groups were compared. Results: The intraoperative remifentanil dosage, anaesthesia anabiosis time, the number of PCIA pressing in 24h after operation, early out-of-bed activity time after operation, and incidence rate of PONV of patients in group TR were all obviously lower than those in group G (P<0.05). The VAS score during rest and exercise immediately after leaving PACU, as well as 2h, 4h, 8h after operation of patients in TR group were obviously lower than those in group G (P<0.05); There had no statistically differences about the VAS score during rest and exercise 12h and 24h after operation between the 2 groups (P>0.05). Conclusions: Ultrasound-guided TAPB combine RSB in overweight surgical patients in Gynaecology can obtain better analgesic effects; At the same time, it can reduce the use of opioids and postoperative adverse reactions, shorten the anaesthesia anabiosis time and promote recovery of patients.

Key words: Ultrasound-guided, Transversus abdominis plane block (TAPB), Rectus sheath block(RSB), Overweight, Gynecological operation

摘要： 目的 观察超声引导下腹横肌平面阻滞（TAPB）联合腹直肌鞘阻滞（RSB）在妇科超重手术患者中的应用效果。方法 择期行开腹全子宫切除术的超重患者60例,随机分为全身麻醉组（G组）、TAPB联合RSB组（TR组）,每组各30例。两组患者均常规行全身麻醉,全麻后G组患者不再进行任何操作,TR组患者在超声引导下行双侧TAPB联合RSB,两组患者术后均连接按标准体重配制的自控式电子静脉镇痛泵（PCIA）。记录两组患者术中瑞芬太尼用量、复苏时间,术后PCIA按压次数、早期下床活动时间及恶心呕吐（PONV）的发生率;比较两组患者出复苏室（PACU）即刻,术后2h、4h、8h、12h、24h时静息及运动VAS评分。结果 TR组患者术中瑞芬太尼用量、复苏时间、术后24小时PCIA按压次数、术后早期下床活动时间及PONV发生率均明显低于G组（P<0.05）。TR组患者出PACU即刻,术后2h、4h、8h,静息及运动时的VAS评分均明显低于G组（P<0.05）;两组患者术后12h、24h静息及运动时的VAS评分比较,差异无统计学意义（P>0.05）。结论 妇科超重手术患者应用超声引导下TAPB联合RSB复合全身麻醉,在获得良好镇痛效果的同时,能减少阿片类药物的使用量和术后不良反应,缩短复苏时间、促进患者术后恢复。

关键词: 超声引导, 腹横肌平面阻滞（TAPB）, 联合腹直肌鞘阻滞（RSB）, 超重, 妇科手术